盆底动态MR扫描与X线排粪造影对女性出口梗阻型便秘的诊断价值比较  

Comparison of Diagnostic Value of Pelvic Floor Dynamic MR Scanning and X-ray Defecation Angiography for Female Outlet Obstructive Constipation

作　　者：丁俞江 王永兵[2] 李刚[2] 谢禹昌[1] 文峰[1] 王煜莹[3] DING Yu-jiang;WANG Yong-bing;LI Gang;XIE Yu-chang;WEN Feng;WANG Yu-ying(Department of Radiology,Shanghai Pudong New Area People's Hospital,Shanghai 201299,China;Department of Anorectal Surgery,Shanghai Pudong New Area People's Hospital,Shanghai 201299,China)

机构地区：[1]上海市浦东新区人民医院放射科,上海201299 [2]上海市浦东新区人民医院肛肠外科,上海201299 [3]上海市浦东新区人民医院中医肛肠科,上海201299

出　　处：《中国医药指南》2019年第24期1-1,6,共2页Guide of China Medicine

基　　金：上海市卫生计生委科研课题(编号:201540418);上海市重点专科(编号:2015-B-18)

摘　　要：目的探讨盆底动态MR扫描与X线排粪造影对女性出口梗阻型便秘的诊断价值比较。方法对符合罗马标准Ⅳ的60例出口梗阻型便秘的中老年女性患者进行改良X线排粪造影及盆底动态MR排粪造影检查,对MR扫描参数进行优化,并对X线和MR的测量数据进行对比研究。结果中老年女性的出口梗阻型便秘多为多类型并发的复杂型。在排粪造影检查中,X线的肛上距变化值(27.16±16.40)mm,肛直角变化值(39.96±11.51)°,较MR的肛上距变化值(18.82±8.67)mm,肛直角变化值(23.17±7.12)°略大,且二者有统计学差异。MR在判断盆底器官下降性病变方面有明显优势,且可对盆底各膈室进行精准测量,膀胱颈的改变值为(28.52±15.21)mm,子宫颈或穹隆的改变值为(36.29±9.81)mm,道格拉斯窝底部的改变值为(10.78±7.64)mm,并可动态观察其形态变化及对周围组织器官的影响。结论X线可对肛直肠部的动态变化进行测量诊断;而盆底动态MR可对盆底4膈室的动态结构变化作整体评估,对出口梗阻型女性患者的动态影像进行量化。建议在X线的基础上选择性增加MR,对准确诊断OOC类型、指导术式,尤其是对治疗或手术后盆底改善情况及疗效判断具备临床参考价值。Objective Compared with dynamic MR defecography and simple X-ray defecography,to explore the diagnostic value for female outlet obstruction constipation.Methods 60 cases of elderly female patients who met the Roman standard IV about outlet obstruction constipation were took the improved simple X-ray defecography and dynamic MR defecography,the scan parameters were optimized and the results of X-ray and MR were compared.Results Most of the elderly female patients were complex types of diseases.Duringdefecation,the change in DUAC was(27.16±16.40)mm,the change in ARA was(39.96±11.51)°by X-ray,the change in DUAC was(18.82±8.67)mm,the change in ARA was(23.17±7.12)°by MR.There was a statistical difference.MR is superior in judging the decline of pelvic floor organs,and can be accurately measured for each diaphragm chamber in the pelvic floor.The change of the bladder neck was(28.52±15.21)mm,the cervix or dome was(36.29±9.81)mm,the bottom of the Douglas nest was(10.78±7.64)mm.MR can be dynamically their morphological changes and their effects on surrounding tissue.Conclusions X-ray can be used to measure and diagnose the dynamic changes in the anus and rectum,while MR can evaluate the dynamic structural changes of pelvic floor 4 diaphragm chamber as a whole.Make the quantifying images of OOC.The selective addition of MR on the basis of X-ray is more significant for the accurate diagnosis of OOC and guiding surgical method.In particular,it is of clinical reference value for the improvement of the situation after treatment or surgery and the judgment of the curative effect.

关 键 词：盆底 排粪造影 出口梗阻型 便秘 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.4[医药卫生—诊断学]